Behavioral coping phenotypes and associated psychosocial outcomes of pregnant and postpartum women during the COVID-19 pandemic

Resilience and mental health among perinatal women: a systematic review

Objective

This review aimed to assess the current evidence on the relationship between resilience and mental health employed in response to the impacts of mental health.

Method

This review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). The protocol of this review was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023470966). Three authors searched peer-reviewed articles using several electronic databases, including Scopus, PubMed/MEDLINE, Psych Info, EMBASE, and Web of Science, from September to October 2023 and included all the studies from any time until November 1, 2023. The review included all eligible quantitative observational and qualitative studies, irrespective of geographical boundaries.

Result

Depression, anxiety, and post-traumatic stress disorders were found to be the most common, but not the only, mental health disorders during the perinatal period, and higher maternal resilience during perinatal periods was found to reduce mental health disorders. It was also found that pregnant women were more resilient to mental health disorders than postpartum women. Tolerance of uncertainty and a positive cognitive appraisal, women's self-behavior and family functioning, and protective psychosocial resources such as dispositional optimism, parental sense of mastery, self-esteem, gratitude, and forgiveness were found to be the most common mechanisms of resilience among perinatal women. Older age, having an adolescent partner, family income, and distress were found to affect resilience.

Conclusion

Noting that women's resilience is an important tool to prevent perinatal mental health disorders, maternal healthcare providers need to counsel perinatal women on resilience-boosting mechanisms, such as applying self-behavior and having social support or close family relationships. It is recommended to counsel or provide psychosocial interventions for the woman's companion or partner to give strong support for the woman in each of the perinatal periods.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=470966, identifier CRD42023470966.

Sleep and Mood Among Women With Histories of Depression When They Used a Responsive Infant Bassinet During the COVID-19 Pandemic

OBJECTIVE

To describe the experiences of women with histories of depression who used a responsive infant bassinet during the first 6 months after birth during the COVID-19 pandemic.

DESIGN

Secondary qualitative descriptive study with analytic expansion.

SETTING

United States.

PARTICIPANTS

Women (N = 139) who gave birth up to 6 months previously and had histories of depression.

METHODS

We used Kyngäs's method of inductive content analysis to analyze 109 open-ended responses that were collected between August 2020 to November 2021 as part of a previously conducted longitudinal study of women who used a responsive bassinet.

RESULTS

Most participants indicated that the responsive bassinet improved their infants' sleep, which, in turn, subjectively improved their sleep and mood. External stressors and challenges presented barriers to good sleep for the participants and their infants, and participants described how these challenges contributed to their symptoms related to mood. When participants reported that they used the responsive bassinet, they shared that their infants were swaddled in the supine sleep position. Participants who did not use the bassinet commonly reported unsafe sleep practices. We identified seven themes from the data: Improved Maternal Sleep Quality, Barriers to Good Maternal Sleep, Mood and Sleep Go Hand and Hand, External Stressors Impair Mood, Improved Infant Sleep Quality, Barriers to Good Infant Sleep, and Safe Sleep Positioning.

CONCLUSION

These findings can be used to inform clinicians on how a responsive bassinet may offer women at high risk for postpartum depression improved sleep and instrumental support. Future researchers should use validated measures to objectively evaluate rates of postpartum depression and sleep quality in high-risk women when using a responsive bassinet.

Pandemic babies: A systematic review of the association between maternal pandemic-related stress during pregnancy and infant development

The COVID-19 pandemic, with its far-reaching influence on daily life, constituted a highly stressful experience for many people worldwide, jeopardizing individuals' mental health, particularly in vulnerable populations such as pregnant women. While a growing body of evidence links prenatal maternal stress to biological and developmental alterations in offspring, the specific impact of prenatal exposure to maternal pandemic-related stress (PRS) on infant development remains unclear. A comprehensive literature search was performed in October 2023 according to the PRISMA guidelines, which yielded a total of 28 records. The selected papers investigated a vast range of developmental and biological outcomes in the offspring with large methodological variations. The reviewed studies showed mixed results. Either direct associations between maternal PRS during pregnancy and infant temperament and socio-emotional development, or indirect links, mediated by maternal mental health, emerged in most studies. Furthermore, maternal PRS was associated with epigenetic and brain alterations in the offspring, although studies were limited in number. Collectively, the reviewed findings contribute to a deeper understanding of the role of early adverse exposures on infant development.

Unfolding of maternal-infant bonding amidst the COVID-19 pandemic: Social support as a risk and protective factor

BACKGROUND

Social, familial, and physiological stressors may put maternal-infant bonding at risk. Therefore, it is plausible that the stressful conditions brought on by COVID-19 could influence maternal-infant bonding. This study aimed to elucidate the contribution of COVID-19-related experience to variance in maternal-infant bonding, beyond that of established risk factors and as moderated by social support.

METHODS

This longitudinal, multicenter study examined the relationship of demographic and obstetric variables, social support, postpartum depression, as well as COVID-19-related fear, exposure, and subjective difficulty with mother-infant bonding six months following birth. Participants (N = 246) were women who delivered during the pandemics' strict lockdown period and were recruited 10 weeks after a liveborn delivery and followed up six months later.

RESULTS

Relationship between fear of COVID-19 and maternal-infant bonding was moderated by social support: Amongst mothers with high levels of social support, fear of COVID-19 negatively predicted bonding.

DISCUSSION

Results indicate that social support, while overall a protective factor for mother-infant bonding, may lose its buffering effect when fear of COVID-19 is high. This relationship was maintained even when early bonding experiences such as forced separation and the risk incurred by postpartum depression were accounted for. Implications for providers are discussed.

Effects of prenatal psychosocial stress and COVID-19 infection on infant attention and socioemotional development

BACKGROUND

The COVID-19 pandemic dramatically altered the psychosocial environment of pregnant women and new mothers. In addition, prenatal infection is a known risk factor for altered fetal development. Here we examine joint effects of maternal psychosocial stress and COVID-19 infection during pregnancy on infant attention at 6 months postpartum.

METHOD

One-hundred and sixty-seven pregnant mothers and infants (40% non-White; n = 71 females) were recruited in New York City (n = 50 COVID+, n = 117 COVID-). Infants' attentional processing was assessed at 6 months, and socioemotional function and neurodevelopmental risk were evaluated at 12 months.

RESULTS

Maternal psychosocial stress and COVID-19 infection during pregnancy jointly predicted infant attention at 6 months. In mothers reporting positive COVID-19 infection, higher prenatal psychosocial stress was associated with lower infant attention at 6 months. Exploratory analyses indicated that infant attention in turn predicted socioemotional function and neurodevelopmental risk at 12 months.

CONCLUSIONS

These data suggest that maternal psychosocial stress and COVID-19 infection during pregnancy may have joint effects on infant attention at 6 months. This work adds to a growing literature on the effects of the COVID-19 pandemic on infant development, and may point to maternal psychosocial stress as an important target for intervention.

IMPACT

This study found that elevated maternal psychosocial stress and COVID-19 infection during pregnancy jointly predicted lower infant attention scores at 6 months, which is a known marker of risk for neurodevelopmental disorder. In turn, infant attention predicted socioemotional function and risk for neurodevelopmental disorder at 12 months. These data suggest that maternal psychosocial stress may modulate the effects of gestational infection on neurodevelopment and highlight malleable targets for intervention.

Alleviating the Effects of the COVID-19 Pandemic on the Physical, Psychological Health, and Wellbeing of Students: Coping Behavior as a Mediator

Background

Public health procedures under the COVID-19 pandemic lockdown policy negatively affect people's health. Students' physical issues have been increased due to restrictions which further impact their psychological and overall well-being.

Objective

The research looks at the influence of coping behavior in mitigating the impact of the COVID-19 epidemic on students' physical/psychological health and general well-being.

Methods

The study's participants were chosen from a pool of 2200 people using convenience sampling. Using an anonymous online poll, the main data were gathered. The collected data were analyzed by using Smart-PLS.

Results

From eight direct correlations, seven were found to be true, except the route pandemic -> overall wellbeing, which was not true. Furthermore, it was shown that the mediating effect of coping behavior was statistically significant in the routes of mediation.

Conclusion

Coping strategies have a significant role in how a person responds to trying circumstances. Our study's results suggest that coping strategies had a statistically significant mediation role in reducing the effects of the COVID-19 pandemic. It is concluded that appropriate coping strategies are an effective adaptation of a protective barrier against the damaging effects of COVID-19 on health.

Influence of the COVID-19 pandemic on prenatal and postpartum patient experiences and well-being

BACKGROUND

It has yet to be fully elucidated how differing populations of obstetric patients adapted to the disruptions in perinatal care and postpartum support from the COVID-19 pandemic. We surveyed an enriched sample of socioeconomically advantaged patients to understand the influence of COVID-19 on their perinatal care experience, well-being, and coping.

METHODS

We surveyed pregnant and postpartum patients (n = 6140) at a large academic medical center in the Midwest of the United States using the Coronavirus and Perinatal Experiences instrument in Spring 2021.

RESULTS

The survey was sent to 6141 pregnant and postpartum patients; 1180 (17.8%) respondents completed the survey, including 256 who were pregnant and 834 postpartum. Most pregnant patients experienced no changes in their prenatal care with 16.5% indicating somewhat worsened care. In the postpartum cohort, 37.5% stated their care had somewhat worsened. In describing influences on stress and mental health, 58.1% of postpartum respondents stated it was moderately, and 17.4% significantly, worse. The pandemic had a somewhat or moderately negative influence for 72.7% of respondents, with 11.0% stating these effects were extremely negative. Both cohorts characterized a range of coping strategies, most commonly, talking with friends and family (76.3%).

CONCLUSION(S)

Even among this sample of socioeconomically advantaged patients, respondents indicated that the pandemic disrupted many facets of their medical care and daily life, especially social activities and postpartum support. Our findings suggest that counseling on coping and adaptation strategies for stressors and increased health systems support be part of perinatal care during public health emergencies for all demographic groups.

Association of inpatient postpartum quality of recovery with postpartum depression: A prospective observational study

STUDY OBJECTIVE

To explore the relationship between Obstetric Quality of Recovery survey (ObsQoR-10-Heb) and Edinburgh postnatal depression scale (EPDS) measured 6 weeks after delivery, adjusted for potential confounding factors.

DESIGN

Prospective, longitudinal cohort study.

SETTING

Large postpartum department, 13,000 annual deliveries, quaternary medical center in Israel.

PATIENTS

Women ≥18 years old, gestational age ≥ 37 weeks after term delivery (spontaneous vaginal, operative vaginal, planned, and unplanned cesarean delivery), with non-anomalous neonates not requiring special support after delivery or at the time of recruitment. Written informed consent was provided. Women unable to read or understand Hebrew were excluded.

INTERVENTIONS

No interventions were done.

MEASUREMENTS

We investigated the relationship between inpatient postpartum recovery and positive postpartum depression (PPD) screening at 6 weeks postpartum. Enrolled women completed the validated Hebrew version of ObsQoR-10 survey (ObsQoR-10-Heb; scored between 0 and 100 with 0 and 100 representing worst and best possible recovery) from 24 to 48 h after delivery, and the Edinburgh Postnatal Depression Scale (EPDS) at 6- and 12 weeks postpartum. We assessed the univariate association between ObsQoR-10-Heb; patient factors; obstetric factors; and positive PPD screening at 6 weeks postpartum. Potential confounders were adjusted in a multiple logistic regression model.

MAIN RESULTS

Inpatient ObsQoR-10-Heb has been completed by 325 postpartum women; 270 (83.1%) and 253 (77.9%) completed the 6- and 12 weeks EPDS respectively. Lower ObsQoR-10-Heb (aOR 0.95 (95% CI 0.92, 0.98); p = 0.001); depression or anxiety before delivery (aOR 4.53 (95% CI 1.88, 10.90); p = 0.001); and hospital readmission (aOR 9.08 (95% CI 1.23, 67.14); p = 0.031) were associated with positive screening for postpartum depression at 6 weeks.

CONCLUSIONS

Our study demonstrates that worse inpatient postpartum recovery is an independent risk factor for positive PPD screening at 6 weeks postpartum. Other risk factors found in our study were maternal hospital readmission and a previous history of anxiety or depression.

COVID-19 pandemic-related trauma symptoms are associated with postpartum alcohol consumption

OBJECTIVE

The COVID-19 pandemic has led to escalations in substance use, including alcohol consumption. Of particular concern are the potential impacts during the postpartum period, a time of heightened vulnerability to stress and potential transmission of the negative sequelae of substance use to offspring. However, postpartum alcohol consumption during the COVID-19 pandemic has not been well characterized.

METHOD

Postpartum drinking habits and COVID-19-related stress were repeatedly assessed (every two weeks for 12 weeks, and at one-, six-, and 12-months postpartum) from N = 378 individuals during the COVID-19 pandemic. Average alcohol use trajectories as well as heterogeneity in trajectories were characterized. COVID-19-related trauma symptoms and coping were examined in relation to alcohol use over time.

RESULTS

Average postpartum alcohol use included an initial quadratic increase from one-to-four-months postpartum, followed by a plateau between four-to-12-months. Higher (15.08%), moderate (26.90%), and lower consumption (57.90%) subgroups were identified. Endorsement of COVID-19-related trauma symptoms and using alcohol to cope with stress predicted higher consumption.

CONCLUSIONS

Findings suggest a potential sensitive period in establishing postpartum alcohol use patterns from one-to-four-months postpartum. Findings further suggest that postpartum alcohol use is heterogenous and that individual response to major traumatic stressors, like the COVID-19 pandemic, may influence emerging patterns of postpartum alcohol use.

Association of stress on eating competence in mothers during pregnancy and six months postpartum

BACKGROUND

Perceived stress is related to poor diet quality and unhealthy dietary patterns in women of reproductive age. Eating competence represents a variety of contextual skills reflecting a comfortable and flexible approach to eating and is associated with diet quality and health related behavior. In non-pregnant samples, perceived stress is negatively associated with eating competence. Given that pregnancy and the postpartum period can be periods of high stress, we hypothesized that higher stress in pregnancy would result in lower pregnancy eating competence.

METHODS

Women (n = 296, mean BMIbaseline pregnancy = 26.3 ± SD 6.0) in the Pregnancy Eating Attributes Study (PEAS) were recruited from the Chapel Hill, North Carolina area. Perceived stress was assessed using the Perceived Stress Scale and eating competence using the ecSatter Inventory at their first trimester and 6-month postpartum visits. We used a mixed effect model to assess the effect of stress by time on eating competence, controlling for baseline pregnancy BMI, race and ethnicity, poverty to income ratio, and WIC status.

RESULTS

Perceived stress was negatively associated with eating competence (b= -0.23, SE = 0.06, p < 0.001). The interaction of stress by time was negatively associated with eating competence (b = -0.15, SE = 0.08, p = 0.03), indicating that the association of stress with eating competence was stronger in postpartum than in pregnancy.

CONCLUSIONS

Perceived stress may adversely impact eating competence during both pregnancy and postpartum. Future studies intervening upon stress or eating competence during pregnancy and postpartum may inform potential causal relations.

Nutrition-Related Experiences of Women With Perinatal Depression During the COVID-19 Pandemic: A Qualitative Study

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to the COVID-19 pandemic: (1) Adaptations in shopping and cooking behaviors; (2) increases in stress and declines in respite; (3) declines in support and increases in isolation; and (4) low levels of breastfeeding guidance. Our findings confirm the importance of resilience among women with perinatal depression and future research is needed to elucidate the mechanisms connecting resilience and dietary behaviors.

Modification and Psychometric Analyses of Stress and Coping Scales for the Extended Postpartum Period

OBJECTIVE

To modify and psychometrically assess two scales that are used to measure stress and coping during the extended postpartum period.

DESIGN

Instrument modification and psychometric assessment.

SETTING

Online, community, and health care settings.

PARTICIPANTS

Mothers with infants who were 2 to 22 months old: 20 in Phase 1 and 373 in Phase 2.

METHODS

In Phase 1, participants from diverse backgrounds served as content experts to recommend modifications of items on two scales: Sources of Stress-Revised (SoS-R) and Postpartum Coping Scale (PCS). The results were 32-item modified versions of each scale. In Phase 2, we conducted a psychometric analysis of both revised scales using principal components analysis to identify dimensionality, Cronbach's alphas to estimate internal consistency reliability, and Pearson correlations to estimate validity of the SoS-R and PCS with the Perceived Stress Scale and the Brief COPE, respectively.

RESULTS

We identified six components for the SoS-R: Overload, Changes After Pregnancy, Baby-Related Concerns, Working Mother Concerns, Low Support Resources, and Isolated Motherhood. The Cronbach's alpha for the SoS-R was .94. The SoS-R subscales demonstrated correlations with the Perceived Stress Scale that ranged from 0.55 to 0.30. We identified six components for the PCS: Self-Regulation, Spiritual Care, Self-Care, Use and Seek Support, Internal and External Resources, and Health Promotion. The Cronbach's alpha coefficients for the PCS ranged from .84 to .66. The highest correlations observed between the PCS subscales and the Brief COPE subscales ranged from 0.67 to 0.26.

CONCLUSION

The SoS-R and PCS each include six components. Internal consistency reliability for all SoS-R subscales and four of six PCS subscales exceeded .70. The dimensions of each scale highlight areas of clinical and research concern.

Symptoms of depression, anxiety and stress in Brazilian mothers during the COVID-19 pandemic

The study aimed to identify the factors associated with symptoms of depression, anxiety and stress in Brazilian mothers of children and adolescents during the COVID-19 pandemic. This is a cross-sectional study carried in 2020 with the participation of 822 mothers who answered an online questionnaire containing sociodemographic variables and the Depression, Anxiety and Stress Scale (DASS-21). The adjusted model showed a higher depression score in women who became unemployed during the pandemic, who felt a greater burden in taking care of children, who took medication on a regular basis, and who self-assessed their health as regular or poor/very poor. Having a lower family income increased their anxiety scale score. In contrast, the variables associated with a reduced anxiety scale score included greater age, not feeling overwhelmed with demands to care for children, not using medications, not having gastrointestinal diseases, and good/very good self-assessed health. These variables, together with the benefits of living in the Northeast and Midwest regions of Brazil as well as sleeping more hours per night, were also associated with reduced stress. The present study is significant as it points out elements present in the daily lives of mothers that have an impact on their mental health. The study points to the need to (re)think mental health policies taking into account the needs of the public studied.

A matter of habit? Stressful life events and cognitive flexibility in 15-month-olds

Exposure to chronic stress is associated with habitual learning in adults. We studied the origins of this association by examining the link between stressful life events and infant cognitive flexibility. The final sample consisted of N = 72 fifteen-month-old infants and their mothers. Mothers completed a survey on pre- and postnatal negative life events. To assess chronic stress physiologically, infant and maternal hair cortisol concentrations were determined for cortisol accumulation during the past 3 months. Each infant participated in two cognitive tasks in the laboratory. An instrumental learning task tested infants' ability to disengage from a habituated action when this action became ineffective (Seehagen et al., 2015). An age-adequate version of the A-not-B task tested infants' ability to find a toy at location B after repeatedly finding it at location A. Correlations between cortisol concentrations and postnatal negative life events (number, perceived impact) did not yield significance. Infant and maternal hair cortisol concentrations were not correlated. Infants' ability to shift to a new action in either task, controlled for acute stress, correlated neither with pre- and postnatal negative life events nor with cortisol concentrations. Taken together, these results indicate that the potential link between long-term stress exposure and cognitive flexibility might not be present in samples with low levels of psychosocial stress.

COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US

Importance

The primary outcomes of the COVID-19 pandemic on the mental health of women with children remain largely unknown.

Objectives

To identify and describe clusters of mothers of children participating in the Environmental influences on Child Health Outcomes (ECHO) Program that characterize pandemic-associated hardships, coping mechanisms, and behaviors, and to evaluate associations between pandemic-associated hardships, coping strategies, and behavior changes with pandemic-associated traumatic stress symptoms.

Design, Setting, and Participants

This multicenter cohort study investigated experiences during the COVID-19 pandemic between April 2020 and August 2021 among maternal caregivers of children participating in the ECHO Program. Data from self-identified mothers of ECHO-enrolled children from 62 US cohorts were included in analyses. Data were analyzed from November 2021 to July 2022.

Exposures

The primary exposures were pandemic-associated changes in mothers' health, health care utilization, work and finances, coping strategies, and health-associated behaviors. Exposures were assessed via a self-reported questionnaire designed by ECHO investigators.

Main Outcomes and Measures

The primary outcome was the total symptoms score of pandemic-associated traumatic stress (PTS), defined as the number of items endorsed at least sometimes or more frequently, from a 10-item self-report measure.

Results

The study surveyed 11 473 mothers (mean [SD] age, 37.8 [7.4] years; 342 American Indian [2.98%], 378 Asian [3.29%], 1701 Black [14.83%], and 7195 White [62.71%]; 2184 with Hispanic/Latina ethnicity [19.04%]) and identified 2 clusters that best characterized their COVID-19 pandemic experiences-one characterized by higher life disruptions (eg, to work and health care), higher social isolation, more coping behaviors to mitigate the outcomes of the pandemic, and more changes to their health behavior routines (high change [1031 mothers]) and the other characterized by lower changes (low change [3061 mothers]). The high change cluster was more socioeconomically advantaged and reported higher PTS (mean [SD] number of symptoms, 3.72 [2.44] vs 2.51 [2.47]). Across both clusters, higher pandemic-associated hardships, coping mechanisms, and behavior changes were associated with higher PTS, and these associations were greater in the low change cluster.

Conclusions and Relevance

In this study of more than 11 000 US mothers, associations between socioeconomic factors, stressful life events, and mental health sequelae were complex. Accordingly, programs, policies, and practices targeting mental health during public health crises such as the COVID-19 pandemic should consider the range and configuration of hardships in designing the most effective interventions to mitigate long-term outcomes.

Impact of COVID-19 Related Maternal Stress on Fetal Brain Development: A Multimodal MRI Study

BACKGROUND

Disruptions in perinatal care and support due to the COVID-19 pandemic was an unprecedented but significant stressor among pregnant women. Various neurostructural differences have been re-ported among fetuses and infants born during the pandemic compared to pre-pandemic counterparts. The relationship between maternal stress due to pandemic related disruptions and fetal brain is yet unexamined.

METHODS

Pregnant participants with healthy pregnancies were prospectively recruited in 2020-2022 in the greater Los Angeles Area. Participants completed multiple self-report assessments for experiences of pandemic related disruptions, perceived stress, and coping behaviors and underwent fetal MRI. Maternal perceived stress exposures were correlated with quantitative multimodal MRI measures of fetal brain development using multivariate models.

RESULTS

Increased maternal perception of pandemic related stress positively correlated with normalized fetal brainstem volume (suggesting accelerated brainstem maturation). In contrast, increased maternal perception of pandemic related stress correlated with reduced global fetal brain temporal functional variance (suggesting reduced functional connectivity).

CONCLUSIONS

We report alterations in fetal brainstem structure and global functional fetal brain activity associated with increased maternal stress due to pandemic related disruptions, suggesting altered fetal programming. Long term follow-up studies are required to better understand the sequalae of these early multi-modal brain disruptions among infants born during the COVID-19 pandemic.

Impact of COVID-19 related maternal stress on fetal brain development: A Multimodal MRI study

Background

Disruptions in perinatal care and support due to the COVID-19 pandemic was an unprecedented but significant stressor among pregnant women. Various neurostructural differences have been re-ported among fetuses and infants born during the pandemic compared to pre-pandemic counterparts. The relationship between maternal stress due to pandemic related disruptions and fetal brain is yet unexamined.

Methods

Pregnant participants with healthy pregnancies were prospectively recruited in 2020-2022 in the greater Los Angeles Area. Participants completed multiple self-report assessments for experiences of pandemic related disruptions, perceived stress, and coping behaviors and underwent fetal MRI. Maternal perceived stress exposures were correlated with quantitative multimodal MRI measures of fetal brain development using ltivariate models.

Results

Fetal brain stem volume increased with increased maternal perception of pandemic related stress positively correlated with normalized fetal brainstem volume (suggesting accelerated brainstem maturation). In contrast, increased maternal perception of pandemic related stress correlated with reduced global fetal brain temporal functional variance (suggesting reduced functional connectivity).

Conclusions

We report alterations in fetal brainstem structure and global functional fetal brain activity associated with increased maternal stress due to pandemic related disruptions, suggesting altered fetal programming. Long term follow-up studies are required to better understand the sequalae of these early multi-modal brain disruptions among infants born during the COVID-19 pandemic.

Negative Emotions, Triggers, and Coping Strategies Among Postpartum Indian Women During Second Wave of COVID-19 Pandemic: Lessons for the Subsequent Waves and Beyond

Introduction

The study aimed to evaluate COVID-19 associated psychological distress among pregnant and postpartum women during the second wave of COVID-19 in India.

Methods

A cross-sectional survey was done using a pre-validated tool involving 491 participants attending a tertiary-care hospital during the second wave of COVID-19 in India.

Results

Three-fourths of participants experienced negative emotions such as fear and various features of depression. Participants (75%) reported COVID-related news on TV/Radio/Newspapers including social media as the major trigger for these negative emotions. Loss of social support mainly affected postpartum women (p < 0.001) and working women (p < 0.001). Inability to access healthcare services had negative associations with age (p < 0.001), education (p < 0.001), and socioeconomic class (p < 0.001). Various coping strategies being followed by participants included watching TV/Videos or reading books (93%), resorting to social media (77%), spending more time praying and meditating (86%), and engaging in hobbies (56%).

Conclusion

During the second wave, the COVID-19 pandemic had a significantly high negative impact on the psychological and social well-being of pregnant and postpartum women. Hence, it is important to initiate appropriate preventive and corrective steps by the policymakers for any future waves of the pandemic.

Experiences, concerns, and needs of pregnant and postpartum women during the Covid-19 pandemic in Cyprus: a cross-sectional study

BACKGROUND

The current COVID-19 pandemic is a unique stressor with potentially challenging and negative consequences on the experiences of pregnant and postpartum women. International literature highlights the pandemic's negative impact on women's perinatal experiences. This is the first study in the scientific literature reporting on the impact of the COVID-19 pandemic, on the perinatal experiences of a large sample of women living in Cyprus.

AIM

To examine the impact of the COVID-19 pandemic on the experiences, concerns and needs of pregnant and postpartum women in Cyprus.

METHOD

The cross-sectional study was conducted from July 2020 to January 2021. A total of 695 women, 355 pregnant and 340 postpartum women (with infants up to 6 months of age), residing in Cyprus were surveyed.

RESULTS

The great majority of the participants (80.9%) perceived the impact of the COVID-19 pandemic on their life as negative. The greatest sources of stress were identified and quantified for their impact on the participants. Our findings indicate that 74.1% of the pregnant women were concerned about changes due to COVID-19 measures impacting the presence of their family at the time of delivery, 57.2% about their newborn's health, and 43.1% about changes related to perinatal care. Postpartum women's concerns were mainly related to the welfare and health of their child (70.3%), whilst half of them (49.1%) expressed concerns about how they were going to care for their baby because of pandemic-related changes. Qualitative data revealed emerging themes as the basis of the pregnant and postpartum women's concerns and needs.

CONCLUSIONS

The COVID-19 pandemic and the associated imposed measures and restrictions had adverse effects on pregnant and postpartum women's perinatal experiences in Cyprus. The women's concerns emphasized the need for the development of specialized, evidenced-based support systems which are essential particularly in pandemic-like situations, when pregnant and postpartum women are more vulnerable to isolation.

The Prevalence of Fear of Childbirth and Its Association With Intolerance of Uncertainty and Coping Styles Among Pregnant Chinese Women During the COVID-19 Pandemic

Background

Fear of childbirth (FOC) is one of the most common psychological symptoms among pregnant women and significantly relates to cesarean section, anxiety, and depression. However, it is not clear the prevalence and risk factors of FOC among Chinese pregnant women since the outbreak of the COVID-19 pandemic.

Aims

The objective of this study was to examine the associations between coping styles, intolerance of uncertainty, and FOC.

Method

From December 2021 to April 2022, a cross-sectional survey was conducted in two hospitals in China through convenient sampling. The cross-sectional survey was conducted among 969 pregnant women, which included the Childbirth Attitude Questionnaire (CAQ), Intolerance of Uncertainty Scale-12 (IUS-12), and Simplified Coping Style Questionnaire (SCSQ).

Results

The total prevalence of FOC was 67.8%. The percentages of women with mild (a score of 28-39), moderate (40-51), and severe FOC (52-64) were 43.6, 20.2, and 4.0%, respectively. The regression results indicated that primiparas, unplanned pregnancy, few spousal support, intolerance of uncertainty, and negative coping styles were significant risk factors of FOC. Women who adopt positive coping strategies experienced a lower level of childbirth fear.

Conclusion

These findings suggest that cultivating positive coping styles and obtaining sufficient childbirth information may be helpful for mothers' mental health. Regular screening assessment of perinatal psychological symptoms, such as the high level of intolerance of uncertainty and negative coping styles, should be adopted to reduce the risk of fear of childbirth.

Resilience in the Perinatal Period and Early Motherhood: A Principle-Based Concept Analysis

A context-specific delineation of research approaches to resilience in the perinatal and early motherhood literature is currently lacking. A principle-based concept analysis was used to establish a description of how women's resilience is currently conceptualised and operationalised within empirical research in the perinatal period and early motherhood (defined as up to five-years postpartum). CINAHL, Medline, PsychInfo, EMBASE, ASSIA, Web of Science, Scielo, Maternity and Infant Care, the Cochrane Library, and the World Health Organization were systematically searched (January/February 2020 and March 2022). Fifty-six studies met the inclusion criteria. Analysis demonstrated interchangeable use of associated concepts such as 'coping', 'coping strategies', and 'adaptation'. Resilience was frequently operationalised as the absence of illness symptomatology, rather than the presence of mental well-being. Investigations of positive areas of functioning were predominately related to the mother's family role. There was limited qualitative exploration of women's perspectives. Recommendations for the pragmatic application of resilience research were not well developed. The narrow operationalisation of resilience by mental ill-health and parental role, and the distinct absence of women's perspectives, restricts the logical maturity and pragmatic application of the concept. Future research may benefit from exploration of women's insights on indicators that might best reflect positive functioning and resilience in this period.

“It's always hard being a mom, but the pandemic has made everything harder”: A qualitative exploration of the experiences of perinatal women during the COVID-19 pandemic

Background

Understanding the psychosocial impacts of the COVID-19 pandemic in vulnerable groups, such as pregnant and parenting women, is a critical research and clinical imperative. Although many survey-based perinatal health studies have contributed important information about mental health, few have given full voice about the experiences of pregnant and postpartum women during the prolonged worldwide pandemic using a qualitative approach.

Objective

The purpose of this study is to explore the lived experience of pregnant and postpartum women in the United States during the ongoing COVID-19 pandemic.

Design

Qualitative phenomenological study.

Setting

This study was conducted in the community, by recruiting women throughout the U.S.

Participants

Fifty-four pregnant and postpartum women participated in qualitative interviews.

Methods

Data from one-on-one semi-structured interviews were analyzed using a team-based phenomenological qualitative approach.

Results

Two key themes were apparent: the pandemic has shined a light on the many typical struggles of motherhood; and, there is a lack of consistent, community-based or healthcare system resources available to address the complex needs of pregnant and postpartum women, both in general and during the pandemic.

Conclusions

Going forward, as the world continues to deal with the current pandemic and possible future global health crises, health care systems and providers are encouraged to consider the suggestions provided by these participants: talk early and often to women about mental health; help pregnant and postpartum women create and institute a personal plan for early support of their mental health needs and create an easily accessible mental health network; conceptualize practice methods that enhance coping and resilience; practice in community-based and interdisciplinary teams (e.g., midwives, doulas, perinatal social workers/ psychotherapists) to ensure continuity of care and to foster relationships between providers and pregnant/ postpartum women; and consider learning from other countries’ successful perinatal healthcare practices.

Registration

Number (& date of first recruitment): not applicable.

Tweetable abstract

Pregnant and postpartum women insist that mental health care must be overhauled, stating the pandemic has highlighted inherent cracks in the system.

Perinatal depression screening and prevention: Descriptive findings from a multicentric program in the South of Italy

INTRODUCTION

Perinatal depression (PD) is a cluster of clinical depressive symptoms occurring globally during pregnancy or after childbirth, with a prevalence of 11.9%. Risk factors for PD among pregnant women may include personality traits of neuroticism, low personal resilience, higher anxiety, avoidance in close relationships, as well as dysfunctional coping strategies.

METHODS

We report on descriptive findings of a screening/prevention program aimed to detect depressive symptoms and associated risk factors in a large sample of women (N = 1,664) accessing the gynecological departments of the Regione Puglia (South of Italy) from July to November 2020. Pregnant women were assessed in their third trimester of pregnancy (T0), after childbirth (T1), and those at risk for PD within 1 year from delivery (T2-T4); The Edinburgh Postnatal Depression Scale (EPDS) has been employed for the screening of PD over time as well as other standardized measures for neuroticism, resilience, coping strategies, and quality of life.

RESULTS

Of 1,664, n = 1,541 were tested at T1, and 131 scored ≥ 12 at EPDS (14.6 ± 2.95), showing a higher risk for PD. They were followed over time at 1, 6, and 12 months after childbirth (T2-T4), and 15 of them scored ≥ 12 (EPDS) at T4. Women with a higher risk of PD also reported higher levels of neuroticism, lower levels of personal resilience, more anxiety and avoidance in close relationships, higher employment of dysfunctional coping strategies (e.g., denial, self-blame, etc.), and lower quality of life (0.0008 < all p < 0.0001).

CONCLUSION

This study confirmed the benefit of screening programs for the early detection of PD among pregnant women. We may suggest a set of risk factors to be considered in the clinical assessment of PD risk as well as the promotion of similar programs to improve depressive outcomes and pathways to care for PD on the basis of a more accurate assessment and referral.